Is this small cell prostate cancer? If so, this is a more serious subtype that can emerge after primary treatment and has neuroendocrine features. Have you considered additional consultations, preferably at a center specializing in prostate cancer? You can benefit from interdisciplinary specialists (urologists, medical oncologists, radiation oncologists) at these institutions.

There have been some clinical trials for RT of paraaortic nodes for PCa, and there are current trials, but it is risky. Some trials are in Phase II and efficacy may not yet be known with certainty and side effects may be serious. Also, your number of nodes may make this approach inadvisable. You can search for ongoing trials at clinicaltrials.gov.

Drug therapy may be the best approach to treat all your current mets and prevent new ones from forming. I'm very sorry you're facing difficult decisions! Please keep us posted.

Djin